Fighting is not tolerated in the sport of ice hockey, except at the junior and professional levels in the USA and Canada. In our opinion, hockey without fighting is a better and safer game.

A no-fighting policy with automatic game ejection is congruent with other professional sports and is consistent with the NHL's aggressive strategy to eliminate hits to the head. Rule changes that deter fighting will reduce the risk of concussion. The fundamental purpose of a hockey fight is to punch the opponent in the face or head, which can result in a significant rotational, concussion-causing force to the brain when compared to an illegal shoulder or elbow hit. Fighting is a head hit.

Players frequently fall during a fight and strike their head on the ice, sometimes without a helmet. An unprotected fall, especially if the player is unconscious or his opponent lands on top of him, can result in severe traumatic brain injury.

Dementia, psychiatric disease and premature death in "enforcers" with a history of on-ice fighting highlight the potential for devastating neurological consequences, which might be related to repeated concussions.

Despite the recent effort to improve recognition of a concussed player and remove him from the game, the diagnosis might be missed after a fight. Dazed players are sent to the penalty box instead of the "quiet room," bypassing the NHL mandate requiring formal evaluation for suspected concussions.

Proponents say fighting is important to self-police the sport, but there is no evidence that fights prevent other dangerous or injurious behaviors. The recent emphasis on rule enforcement and player suspensions will prove to be effective deterrents. Fighting is negative role modeling for younger hockey players and directly contradicts efforts that promote safety and mutual respect. Hockey can mend public perception by eliminating all fights regardless of whether they are spontaneous, staged or retaliatory.

Lack of fighting in world junior and Olympic competition does not diminish quality; it enhances hockey. The skilled, fast and physical international game has proved to be an unsurpassed spectator experience.

Contact sports are being scrutinized because of concussion concerns. The future of ice hockey hinges on our collective efforts to improve the safety of this great game — and the time is now.

Stuart, Dodick and Smith are with the Mayo Clinic. Stuart, chief medical officer for USA Hockey, has two sons, Mike and Colin, who played in the NHL and one, Winnipeg Jets defenseman Mark Stuart, playing now. Daughter Cristin played for Boston College.